Actualización en técnicas de blanqueamiento de baja agresividad sobre dientes vitales: una necesidad ética y legal (segunda parte) / Update in whitening techniques lessaggressive on vital teeth: an ethical and legal necessity (second part)

En esta segunda parte se complementan las pautas y recomendaciones de utilización delas técnicas de blanqueamiento seleccionadas como menos agresivas. También se revisan las técnicas de control de resultados clínicos (medición del color) que pueden ser más aplicables en la clínica odontológica. En ella se presentan cuatro casos clínicos tratados con los principios de actuación defendidos como menos nocivos y unas conclusiones a modo de resumen, tanto dela primera como de la segunda parte (AU)

In this second part, the guidelines and recommendations for use of whitening techniques selected as less aggressive are complemented. The control techniques of clinical results (colour measurement) thatcan be more applicable in the dental clinic are also reviewed. Four clinical cases which are treated with the operational principles defended as less harmful and some conclusions in summarized form, from the first as well as the second part, are presented (AU)

Actualización en técnicas de blanqueamiento de baja agresividad sobre dientes vitales: una necesidad ética y legal (primera parte) / Update in whitening techniques less aggressive on vital teeth: an ethical and legal necessity (first part)

El presente trabajo trata de revisar aquellas técnicas de blanqueamiento menos agresivas tanto para los tejidos propios del diente como para los tejidos adyacentes evaluando sus ventajas e inconvenientes frente a otras técnicas más agresivas y que actualmente se encuentran muy difundidas a través de campañas publicitarias muy agresivas, en ocasiones carentes de suficiente sustentación científica. En el mismo presentamos algunos casos clínicos tratados con técnicas de blanqueamiento de baja agresividad, que pueden servir de apoyo a las opiniones que aquí serán vertidas (AU)

This work deals with reviewing those whitening techniques that are less aggressive on tissues of the teeth themselves as well as on the adjacent tissues, evaluating their advantages and disadvantages compared to other more aggressive techniques that are currently disseminated, supported by some very aggressive advertising campaigns and upon occasion lacking sufficient scientific support. In it we present some clinical cases dealing with less aggressive whitening techniques that can serve as support for the opinions that will be presented here (AU)

Ethical marketing in'aesthetic' ('esthetic') or'cosmetic dentistry'. Part 1.

UNLABELLED: Prior to undertaking any elective,'cosmetic' dental procedures, it is vital for the treating dentist to discuss the merits and drawbacks of all viable options. It is important that the patient understands what the consequences and limitations of treatment are likely to be, and what the potential failures could entail later in his/her life. Informed consent should be obtained (preferably in writing) and the clinical notes and records should be clearly documented, with accurate and concise details provided of all the investigations carried out, and their findings, as well as including details of the various discussions that have taken place. Dentists need to be aware of the existence of heightened expectations in this group of patients and be cautious about accepting patients who have unrealistic 'cosmetic' expectations. Where possible, cosmetic or aesthetic dental treatment should be provided which is minimally destructive and, in the long-term, be in the 'best interests' of the patient. Important matters such as the gaining of informed consent and maintaining meticulous, contemporaneous dental records will also be emphasized. It is hoped that the article will provide clear definitions of some commonly used terms such as 'ethical marketing', 'ethics', and 'values', which are often used in association with the marketing, planning and undertaking of supposedly 'cosmetic' dental procedures. The important role of less invasive alternative treatment options will also be emphasized. CLINICAL RELEVANCE: The aims of this article are to consider the common pitfalls that may arise when contemplating the marketing and provision of invasive,'cosmetic, dental restorations and to discuss how best to avoid a dento-legal claim where such treatment plans may not fulfil the patient's desired outcome.

Tooth bleaching--a critical review of the biological aspects.

Present tooth-bleaching techniques are based upon hydrogen peroxide as the active agent. It is applied directly, or produced in a chemical reaction from sodium perborate or carbamide peroxide. More than 90% immediate success has been reported for intracoronal bleaching of non-vital teeth, and in the period of 1-8 years' observation time, from 10 to 40% of the initially successfully treated teeth needed re-treatment. Cervical root resorption is a possible consequence of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic procedure. When the external tooth-bleaching technique is used, the first subjective change in tooth color may be observed after 2-4 nights of tooth bleaching, and more than 90% satisfactory results have been reported. Tooth sensitivity is a common side-effect of external tooth bleaching observed in 15%-78% of the patients, but clinical studies addressing the risk of other adverse effects are lacking. Direct contact with hydrogen peroxide induced genotoxic effects in bacteria and cultured cells, whereas the effect was reduced or abolished in the presence of metabolizing enzymes. Several tumor-promoting studies, including the hamster cheek pouch model, indicated that hydrogen peroxide might act as a promoter. Multiple exposures of hydrogen peroxide have resulted in localized effects on the gastric mucosa, decreased food consumption, reduced weight gain, and blood chemistry changes in mice and rats. Our risk assessment revealed that a sufficient safety level was not reached in certain clinical situations of external tooth bleaching, such as bleaching one tooth arch with 35% carbamide peroxide, using several applications per day of 22% carbamide peroxide, and bleaching both arches simultaneously with 22% carbamide peroxide. The recommendation is to avoid using concentrations higher than 10% carbamide peroxide when one performs external bleaching. We advocate a selective use of external tooth bleaching based on high ethical standards and professional judgment.